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NPI Code Detail

MEDICARE: IAN A STINE M.D.

MEDICARE: IAN A STINE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianA89303CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CP2106OTHERCAMEDICARE RAILROAD

General Provider Information

NPI Number : 1154544468
Entity Type Code : Individual
Provider Name (Legal Business Name) : IAN A STINE M.D.
Provider Business Mailing Address
First Line : 4626 WILLOW RD
Second Line : SUITE 200
City : PLEASANTON
State : CA
Zip : 94588-8517
Country : US
Telephone Number : 925-463-0470
Fax Number : 925-463-0473
Provider Business Practice Location Address
First Line : 4626 WILLOW RD
Second Line : SUITE 200
City : PLEASANTON
State : CA
Zip : 94588-8517
Country : US
Telephone Number : 925-463-0470
Fax Number : 925-463-0473
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 02/27/2025

Similar Medicare Providers

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Practice Location Address:
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1265437396 — KAMBIZ BEHZADI MD
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1033114178 — DAVID J JUPINA M.D.
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1295730331 — GREGORY HORNER M.D.
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1851732572 — LAURA SONODA M.D.
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Directions to “ IAN A STINE M.D.” Practice Location

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